Everything you need to know about piriformis syndrome

Piriformis syndrome might sound like a scary, rare condition, but it's a common injury that runners can suffer from that is easy to resolve.

The syndrome affects the piriformis muscle – one of the muscles in the hip – and a telltale sign that you're affected is a literal pain in the bum when exercising.

It's fairly easy to get to the bottom of, though, and there are a number of stretches, exercises and self-massaging techniques you can try at home before seeking specialist help.

Here, Lila Aid, Senior MSK physiotherapist at the London Bridge Hospital, explains what causes piriformis syndrome, how to treat the condition, and ways to prevent it from happening in the first place.

What is the piriformis?

Before delving into problems with the piriformis, it's worth establishing where (and what) it is. A small, pyramid-shaped muscle found in the hip, it connects the front of the sacrum (the base of the spine) to the top of the femur (thigh bone). It is part of the lateral rotator group of muscles that control the leg's rotation away from the body and works alongside your two smaller glute muscles (gluteus medius and minimus) to stabilise your pelvis.

'It helps to prevent the pelvis from dropping when you're walking or running and helps prevent the femur from rotating inwards,' says Aid. 'The muscle's job is both lateral and as an outer stabiliser of the hip.'

What is piriformis syndrome?

'Piriformis syndrome is a bit of a vague terminology,' explains Aid. 'It can just be the muscle itself becoming quite tight from overuse or direct trauma, but some people interpret it as a cause of sciatica – in a proportion of the population, the sciatic nerve runs through the muscle belly of the piriformis, [and constriction of the sciatic nerve] can give pain all the way down the back of the leg.'

Common symptoms of piriformis syndrome are pain deep in the buttock region, but discomfort can also be present in the lower back, hip, and back or side of the leg.

'The severity will affect people differently,' says Aid. 'Some people will just [feel it] when they're working the muscle – so walking, running, things like squats or lunges, or when that muscle is stretched or being compressed it might be aggravated. Sitting cross-legged can particularly irritate it because it will be stretching the muscle lying on that side. Obviously, if it's really severe, the pain can be constant.

'If it's just the buttock pain, you can probably try [stretches and exercises],' but she adds that if it is sciatica, it's best to see a specialist. Other symptoms of the irritated nerve include 'lower-back pain, pain that radiates all the way down the leg, any sort of pins and needles or numbness down the leg, or any weakness – like dragging the leg or tripping up.'

What causes piriformis syndrome?

Piriformis syndrome is a classic overuse injury, which makes running a prime trigger of the condition. 'There's a lot of pelvic rotation, a lot of impact going through the legs,' says Aid.

She explains that it could be that your piriformis itself is weak, your glutes are weak (meaning your piriformis is forced to compensate to pick up the slack), or the whole lateral complex might not be working as it should.

'Statistically, it's slightly more common in women because of the Q [quadriceps] angle of women's legs,' she adds. 'Their femur bone goes inwards a bit. It's why women are more prone to a lot of lower-limb injuries.'

How do you test for piriformis syndrome?

While there's no defined way of self-diagnosing if you have piriformis syndrome other than the symptoms listed above, Aid says you can 'have a really good feel into your bottom area' to see if you can pinpoint the tender area but warns 'there are other muscles in there and other things that could be going on so [going to see a physiotherapist is] probably for the best because you don't want to be aggravating it or doing the wrong thing.'

How do you treat piriformis syndrome?

If you're suffering from the symptoms of piriformis syndrome, Aid recommends not to ignore it and modify your activity levels to avoid it becoming irritated: 'Often people say it will start to hurt after four or five miles running or an hour walking or standing, so cut it down to a level where you can exercise comfortably without aggravating the pain.'

Alongside a reduction in the activity that seems to be causing the problem, she recommends adding a 'progressive strengthening and stretching of that muscle area'.

Not only will this gradually help relieve some of the pain, but it will also build up your piriformis muscle's strength to prevent it from happening again.

One simple and quick bit of relief can be found if you have a tennis ball to hand: 'If the muscle's got really tight and is really painful, foam rolling or a tennis ball massage can be really good to help release it – literally getting a tennis ball, sitting on it and really leaning into it is something that you can do at home.'

What exercises can you do to help piriformis syndrome?

Stretching the piriformis is relatively straightforward, and Aid has two different techniques that she uses with clients.

The first sees you lying on the floor and bending the affected side's leg at the knee. Cross the bent knee over your straight leg and hug it with the unaffected side's arm into your chest.

The second involves sitting upright on the floor with both legs out straight in front of you. Bend the affected side at the knee and cross the bent leg's foot over the straight leg's knee. While in this position, twist the top half of your body towards the affected side to get the full stretch.

Both should be held for 'a good 20-to-30 seconds,' says Aid. 'With stretching, the focus is more on the time that you hold it than the number of repetitions – you only need to do it once or twice and make sure it's a really good stretch.'

When it comes to strengthening the piriformis, she explains that a number of bodyweight exercises that are common in Pilates are great: 'You can do all sorts: leg raises on your side, clam shells, fire hydrants, donkey kicks, glute bridges – although single leg is probably better or pushing out against a resistance band.'

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